The present disclosure relates to an apparatus of a minimal invasive surgery, and more particularly, to a rod inserter for fixing a pedicle screw, which is capable of quickly and easily coupling one rod corresponding to lordosis of a person to be surgically operated (hereinafter, referred to as a subject person) to a plurality of screw heads respectively fixed to vertebrae of the subject person to perform a surgical operation, a screw holder with a joint for the minimal invasive surgery, a screw reducer for the minimal invasive surgery, and an apparatus for the minimal invasive surgery using these devices.
A disk between vertebrae functions as a joint and plays very important roles for minimizing an impact applied to the vertebrae while vertebral pulp changes in position and shape according to movement of the vertebrae.
When an operation for removing a seriously dented or damaged disk due to the aging, accidents, or the like is performed, measures for maintaining a space between vertebrae and preventing the vertebrae from being deformed or shaken have to be done.
For this, spine-disk patients may be operated according to following procedures.
That is, a disk corresponding to a damaged portion of the vertebra is removed so that the damaged portion of the vertebra is not pushed or pressed, and then, bone fragments are filled into a hollow artificial aid (cage) formed of a metal or plastic material, and the artificial aid is inserted into the portion of the vertebra from which the disk is removed.
Sequentially, a pedicle screw is inserted into each of portions of the vertebra, which correspond to upper and lower sides of the damaged disk, and then, a rod is connected to the pedicle screw to secure a distance between the vertebrae, thereby normally realizing osseointegration (hereinafter, referred to an operation 1).
When a disk between vertebrae is lightly damaged in spine-disk patients, an operation may be performed as follows. That is, the disk leaves it as it is, and a pedicle screw is inserted into and fixed to each of portions of the vertebra, which correspond to upper and lower sides of the damaged disk, and then, a rod is connected to the pedicle screw to secure a distance between the vertebrae, thereby preventing the damaged disk from being worsen (hereinafter, referred to as an operation 2).
However, since the operations 1 and 2 essentially require a process of cutting a skin corresponding to the damaged vertebra by a predetermined size so as to couple the rod to the pedicle screw after the pedicle screw is coupled to the vertebra, an invasive portion may be large to cause limitations in which recovery of the patient is delayed, and satisfaction after the operation is low due to the wound.
As the inventions from the foregoing points of view, there are Korean Patent Registration No. 10-0623441, titled “MINIMAL INVASIVE SPINE ROD INSERTER” (hereinafter, referred to as a ‘prior art 1’, Korean Patent Registration No. 10-0811563, titled “THE MINIMALLY INVASIVE INSTRUMENT OF SPINAL FIXATION DEVICE” (hereinafter, referred to as a ‘prior art 2’), Korean Patent Registration No. 10-0942226, titled “ROD HOLDER AND MINIMALLY INVASIVE SYSTEM FOR SPINAL SURGICAL OPERATION USING THE SAME” (hereinafter, referred to as a ‘prior art 3’), Korean Patent Registration No. 10-1067664, titled “MINIMALLY INVASIVE INSTRUMENT FOR SPINAL FIXATION” (hereinafter, referred to as a ‘prior art 4’), and Korean Patent Registration No. 10-1419807, titled “WORKING TOWER FOR MINIMALLY INVASIVE SURGERY SYSTEM” (hereinafter, referred to as a ‘prior art 5’).
However, the prior arts 1 to 5 may be applied up to a 2-level operation, but may not be applied to 3-level or more operations.
Here, an n-level (where n is an integer equal to or greater than 1) denotes a state in which n+1 pedicle screws are respectively fixed to n+1 vertebrae.
Referring to FIG. 14, the prior arts 1 to 4, and particularly, the prior art 5 may not be applied to 3-level or more operations.
That is, in case of the prior art 5, a lower end of a screw holder 10 having both penetrated ends is detachably coupled to a head 41 of a pedicle screw 40 fixed to a vertebra (not shown).
Here, although not particularly shown, in case of a 1-level or 2-level operation, i.e., when the total 2 or 3 pedicle screws 40 are respectively fixed to 2 or 3 vertebrae, a rod insertion guide slot 11 that is cut upward by a predetermined length from both sides of an edge of the lower end of the screw holder 10 and a rod insertion groove 42 that is cut downward from both sides of an edge of an upper end of the head 41 communicate with each other.
Thus, the rod is inserted to pass through the rod insertion guide slot 11. Here, the prior art 5 in addition to the prior art 1 to 4 may be applied to only the 1-level or 2-level operation.
This is done because, in case of the prior arts 1 to 5, a fatal accident in which the screw holder 10 is separated from the head 41 due to the states of the pedicle screws 40 fixed to the vertebrae at various angles different from each other while an operator forcibly inserts one rod into the rod insertion guide slot 11 of each of five screw holders 10 in the state of a level exceeding a 3-level, i.e., the 4-level as illustrated in FIG. 14.
Particularly, in the state of the 3-level or more, the operation itself may be impossible in the prior arts 1 to 5. In addition, it is difficult to allow the rod that is elongated as the level number increases, for example, from the 1-level to the 2-level to pass to be inserted by using a single device.
Also, there are several technologies for reducing the spinal rod into the rear pedicle screw in the spine surgery fields.
The main technology may be designed so that the rod is individually reduced into each of the pedicle screws one level at a time by using a separate rod reducing mechanism such as rocker forks or ratchet-type mechanisms, which is connected to the head of the pedicle screw after the screw is inserted, and the rod is disposed.
In these reducing technologies, a large axial load may be applied to the pedicle screws.
The rod may match specific deformity and then be mounted inside the implanted pedicle screw. When the rod is mounted inside the implanted pedicle screw as described above, since the rod is bent to its original position, the deformity may be corrected.
However, in these technologies, a time is spent, and stress and deformation may be applied to the rod prior to the implantation.
The specific rod reducing technologies may use special reducing pedicle screws including upwardly extending integrated taps that are used to gradually reduce the rod over the whole length of the deformity. When the reducing is completed, the extending taps are separated from each other.
However, these technologies have a limitation in which the technologies are generally limited to only the reducing screw, and high costs are required for the implantation.